[New aspects in the management of renal osteodystrophy]

Our knowledge of the mineral metabolism disturbances and skeletal disorders in patients with chronic renal insufficiency has advanced significantly in the last years. Probably the most important what we have learned is, that apart of bone disease, hyperparathyroidism and its treatment can also lead to severe extra-skeletal complications, contributing to the progression of cardiovascular disease in this population. This fact has fundamentally changed our approach to the treatment, and - as a result - the new clinical practice guidelines on the management of mineral metabolism and bone disease in chronic renal failure have been developed. Mainstays of the new approach are lower recommended serum calcium and calcium-phosphate product. However, these targets are very difficult to achieve in clinical practice. During the last decade, some additional therapeutic agents have been welcomed. There are two effective calcium-free, aluminium-free phosphate binders, sevelamer hydrochloride, and lanthanum carbonate, four vitamin D analogues of newer generation, and--last but not least--modulators of calcium-sensing receptor, calcimimetics. Future studies will be needed to determine how these recent developments will be helpful. The optimal therapy for all end-stage renal failure complications is definitely renal transplantation.